Reconstruction of 2 adjacent soft tissue defects of digits with free twin-lobed flap of carpal cutaneous branch of ulnar artery / 中华显微外科杂志

ABSTRACT

Objective:To explore the surgical procedure and effect of reconstruction of 2 adjacent soft tissue defects of digits with free twin-lobed flap of carpal cutaneous branch of ulnar artery.Methods:From January 2015 to February 2022, 6 patients (10 digits) with 2 adjacent soft tissue defects of digits were treated by free twin-lobed flap of the carpal cutaneous branch of ulnar artery in the Department of Hand and Wrist Surgery of Sichuan Orthopaedic Hospital. All patients were males, aged 35-53 years old, with an average age of 39.5 years old. Three patients were with soft tissue defects in palmar of index and middle fingers, 1 in palmar of middle and ring fingers, 1 in palmar and dorsal of thumb and 1 in palmar and radial of index finger. Nerves in 5 injured digits of 3 patients and the defected digital flexor tendons in 2 digits of 2 patients were reconstructed. The defects were 2.5 cm× 1.5 cm - 4.0 cm× 2.0 cm in size. The sizes of the flaps were 7.5 cm×2.0 cm-10.0 cm×3.0 cm. The donor sites were directly sutured. All of the defects were treated in emergency surgery. The survival rate of flaps was observed after surgery. All patients were included in postoperative follow-up via telephone or WeChat reviews after discharge to observe the flaps and function recovery of digits.Results:All flaps survived without complication. Venous occlusion occurred in 1 digit, which was relieved after suture removal and heparin dressing for 3 days. Follow-ups lasted 12-16 (mean 12.8) months. The texture and appearance of the flaps were satisfactory. Sensory recovery was at S 3-S 3+ with static two-point discriminations (TPD) at 7-12 mm in the digits with sensory reconstruction. In the digits without nerve repair, the flaps gradually regained protective sensation and the function of digits satisfactorily recovered at 6 months after surgery. According to the Evaluation Standard of Upper Limb Function of Hand Surgery Branch of the Chinese Medical Association, 5 patients were in excellent and 1 in good. Conclusion:Using a free twin-lobed flap with carpal cutaneous branch of ulnar artery to reconstruct 2 adjacent defects of digits can benefit from the thickness of flap being similar to the skin of hand and a hidden donor site together with satisfactory appearance, texture and function of the flap. It is an effective method in reconstruction of 2 adjacent soft tissue defects of digits.